Sehgal S, Datta U, Mujtaba S, Sood A, Vinayak V K
Departments of Immunopathology & Internal Medicine PGIMER, Chandigarh, India.
Methods Cell Sci. 2002;24(1-3):107-14.
There has been an exponential rise of HIV positive patients as observed at the surveillance center of Nehru Hospital. Most patients are poor and cannot afford repeated viral load assays. Therefore, there is a need to identify cost effective and reliable surrogate markers of disease activity. In the present study absolute number of CD4 cells, beta2 micro-globulin, circulating nucleosomes were studied in 30 patients of AIDS, 30 seropositives and 30 healthy controls. In addition viral load, P-24 assay, and TNFR-II assays were done in seropositive and AIDS patients. The mean CD4 cells in patients with AIDS were 69.66 +/- 68.25 mm3 while in seropositives values was 370 +/- 201.29 mm3. The mean CD4 cells in healthy controls were however 690 +/- 198 mm3. The differences in all the groups were highly significant (p<0.001). The mean CD4 values in Indians are significantly lower than reported from the west. The lower number of CD4 cells in healthy population is interpreted to be due to immune activation. The CD8 cell number in controls was 650 +/- 207 mm3 this figure is also higher than that observed in the west. P-24 assay failed to delineate between seropositives and patients with AIDS. Although, beta2 microglobulin levels were significantly higher in AIDS than in seropositives and higher in seropositives than in controls yet with the best possible cut off, it had a sensitivity of only 70% in delineating the two conditions. The correlation between CD4 cells and viral load was more significant when the CD4 cells were below 200 mm3. Five out of 30 patients with a CD4 of 300-600 mm3 had a viral load of over 1 x 10(5) cop/ml. The difference in TNF R-II levels between seropositives and AIDS was however more impressive. With a cut off of 550 pg/ml it had a sensitivity of 95% in delineating HIV from AIDS. It is concluded that a combination of absolute number of CD4 cells and TNF R-II assay along with clinical evaluation may be used to monitor therapy in resource poor countries where frequent viral load assay is unaffordable.
据尼赫鲁医院监测中心观察，艾滋病毒阳性患者数量呈指数级增长。大多数患者贫困，无力承担多次病毒载量检测费用。因此，有必要确定具有成本效益且可靠的疾病活动替代标志物。在本研究中，对30例艾滋病患者、30例血清阳性者和30例健康对照者的CD4细胞绝对计数、β2微球蛋白、循环核小体进行了研究。此外，还对血清阳性者和艾滋病患者进行了病毒载量、P - 24检测和肿瘤坏死因子受体II（TNFR - II）检测。艾滋病患者的平均CD4细胞数为69.66±68.25/mm³，而血清阳性者的值为370±201.29/mm³。然而，健康对照者的平均CD4细胞数为690±198/mm³。所有组之间的差异具有高度显著性（p<0.001）。印度人的平均CD4值显著低于西方报道的值。健康人群中CD4细胞数量较低被认为是由于免疫激活。对照组的CD8细胞数为650±207/mm³，这一数字也高于西方观察到的数字。P - 24检测无法区分血清阳性者和艾滋病患者。尽管艾滋病患者的β2微球蛋白水平显著高于血清阳性者，血清阳性者的水平又高于对照组，但即使采用最佳临界值，在区分这两种情况时其敏感性也仅为70%。当CD4细胞低于200/mm³时，CD4细胞与病毒载量之间的相关性更为显著。30例CD4细胞数为300 - 600/mm³的患者中有5例病毒载量超过1×10⁵拷贝/毫升。然而，血清阳性者和艾滋病患者之间肿瘤坏死因子受体II（TNF R - II）水平的差异更为显著。以550 pg/ml为临界值，在区分艾滋病毒感染者和艾滋病患者时其敏感性为95%。得出结论：在资源匮乏的国家，当频繁的病毒载量检测费用难以承受时，可将CD4细胞绝对计数、TNF R - II检测与临床评估相结合用于监测治疗。
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